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| Microorganisms | Swiss guidelines (2007) | French guidelines (2008) | IDSA guidelines (2013) |
| Staphylococcus aureus or coagulase negative staphylococci |
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| Methicillin-susceptible | Rifampin 450 mg/12 h (IV/PO) + flucloxacillin 2 g/6 h (IV)
for 2 weeks followed by oral route: rifampin 450 mg/12 h + ciprofloxacin 750 mg/12 h or levofloxacin 750 mg/d or 500 mg/12 h | (Oxacillin or cloxacillin) 100–200 mg/kg/d (IV) or cefazolin 60–80 mg/kg/d (IV) if penicillin allergy
+ rifampicin 20 mg/kg/d (IV/P.O.)
for 2 weeks followed by oral route
(i) First-line treatment:
rifampicin 20 mg/kg/d
+
(ofloxacin 400–600 mg/d or pefloxacin 800 mg/d or ciprofloxacin 1500–2000 mg/d or levofloxacin 500–750 mg/d)
(ii) Alternatives to first-line treatment:
(1) rifampicin 20 mg/kg/d
+ fusidic acid 1500 mg/d
(2) rifampin 20 mg/kg/d
+ clindamycin 1800–2400 mg/d (if erythromycin-susceptible)
(3) ofloxacin 400–600 mg/d or pefloxacin 800 mg/d or ciprofloxacin 1500–2000 mg/d or levofloxacin 500–750 mg/d
+ fusidic acid 1500 mg/d
(4) clindamycin 1800–2400 mg/d (if erythromycin-susceptible)
+ fusidic acid 1500 mg/d
(5) rifampicin 20 mg/kg/d
+ cotrimoxazole/trimethoprim 3200 mg/640 mg if no alternative possible | Nafcillin, sodium 1.5 to 2 g/ 4 to 6 h (IV) or cefazolin 1 to 2 g/8 h (IV) or ceftriaxone 1 to 2 g/d + rifampin as a
companion drug for rifampin-susceptible
PJI treated with debridement and
retention or 1-stage exchange in text
Alternatives:
vancomycin 15 mg/kg/12 h (IV)
or
daptomycin 6 mg/kg/d (IV)
or
linezolid 600 mg/12 h (IV/PO)
+ rifampin as a
companion drug for rifampin-susceptible
PJI treated with debridement and retention or 1-stage exchange |
|
| Methicillin-resistant | Rifampin 450 mg/12 h (IV/PO) + vancomycin 1 g/12 h IV
for 2 weeks followed by
(1) rifampin 450 mg/12 h (PO) + ciprofloxacin 750 mg/12 h (PO) or levofloxacin 750 mg/d or 500 mg/12 h (PO)
(2) rifampin 450 mg/12 h (PO) in addition to
(i) teicoplanin 400 mg/24 h after loading dose (IV/IM)
(ii) or fusidic acid 500 mg/8 h (PO)
(iii) or cotrimoxazole/trimethoprim 1 tablet/8 h (PO)
(iv) or minocycline 100 mg/12 h (PO) | Vancomycin 40–60 mg/kg/d (continuous) after a loading dose (15 mg/kg) IV or teicoplanin 12 mg/kg/12 h during 3–5 d then followed by 12 mg/kg/d
+ rifampin 20 mg/kg/d (IV/PO)
Alternatives to rifampin:
fusidic acid 1500 mg/d (IV/PO)
or fosfomycin 150–200 mg/kg (IV)
or doxycycline 200 mg/d (PO)
or clindamycin 1800–2400 mg/d (if erythromycin-susceptible) + gentamicin
for 2 weeks followed by oral route if possible
Rifampicin 20 mg/kg/d in addition to
(1) fusidic acid 1500 mg/d
(2) or clindamycin 1800–2400 mg/d (if erythromycin-susceptible)
(3) or cotrimoxazole/trimethoprim 3200 mg/640 mg
(4) minocycline 200 mg/d
(5) doxycycline 200 mg/d
(6) linezolid 1200 mg/d | Vancomycin 15 mg/kg/12 h (IV) + rifampin as a
companion drug for rifampin-susceptible
PJI treated with debridement and
retention or 1-stage exchange
Alternatives:
daptomycin 6 mg/kg/d (IV) or
linezolid 600 mg/12 h (IV/PO)
+ rifampin as a
companion drug for rifampin-susceptible
PJI treated with debridement and retention or 1-stage exchange |
|
| Streptococcus spp. | Penicillin G 5 million units/6 h (IV)
or ceftriaxone 2 g/d (IV)
for 4 weeks followed by
amoxicillin 750–1000 mg/8 h (PO)
(except S. agalactiae) | Amoxicillin 100–200 mg/kg/d
+ gentamicin
for 2 weeks then followed by amoxicillin or clindamycin 1800–2400 mg/d | Penicillin G 20 to 24 million units/d (IV)
or
ceftriaxone 2 g/d (IV)
alternatives
Vancomycin 15 mg/kg/12 h |
|
| Enterococcus spp. (penicillin. susceptible) | Penicillin G 5million units/6 h (IV)
Or ampicillin or amoxicillin 2 g/4–6 h (IV)
+ aminoglycoside
for 2 to 4 weeks followed by amoxicillin 750–1000 mg/8 h (PO)
(and S. agalactiae) | Amoxicillin 100–200 mg/kg/d
+ gentamicin
for 2 weeks then followed by oral route:
amoxicillin 100–200 mg/kg/d + rifampin 20 mg/kg/d if susceptible | Penicillin G 20 to 24 million units/d (IV)
or
ampicillin sodium 12 g/d (IV) (continuously or in 6 divided doses)
Alternatives:
vancomycin 15 mg/kg/12 h (IV)
or
daptomycin 6 mg/kg/d (IV)
or
linezolid 600 mg/12 h (PO/IV) |
|
| Enterococcus spp. penicillin-non susceptible | Vancomycin 15 mg/kg/12 h (IV)
+ aminoglycoside
| Vancomycin 40–60 mg/kg/d (continuous) after a loading dose (15 mg/kg) IV
or teicoplanin 12 mg/kg/12 h during 3–5 d then followed by 12 mg/kg/d
+ rifampin if susceptible or gentamicin. | Vancomycin 15 mg/kg/12 h (IV)
Alternatives:
daptomycin 6 mg/kg/d (IV)
or
linezolid 600 mg/12 h (PO/IV) |
|
| Enterobacteriaceae quinolone susceptible | Ciprofloxacin 750 mg/12 h (PO) | (Cefotaximi 100–150 mg/kg/d or ceftriaxone 30–35 mg/kg/d) (IV)
+ (ciprofloxacin 1500–2000 mg/d or
ofloxacin 400–600 mg/d) (IV/PO)
or gentamicin
Alternatives:
(imipenem 2-3 g/d or meropenem 3–6 g/d) +
gentamicin
Then followed by oral route if quinolone susceptible:
ciprofloxacin 1500–2000 mg/d or
ofloxacin 400–600 mg/d) | IV β-lactam based on in vitro susceptibilities
or
ciprofloxacin 750 mg/12 h (PO)
For Enterobacter spp.:
Cefepim 2 g/12 h (IV)
or
ertapenem 1 g/d (IV)
Alternatives:
ciprofloxacin 750 mg/12 h (PO)
or 400 mg/12 h (IV) |
|
| Nonfermenters (e.g., Pseudomonas spp.) | Cefepime or ceftazidim2 g/8 h (IV)
+ aminoglycoside
For 2 to 4 weeks followed by: Ciprofloxacin 750 mg/12 h (PO) | (Ceftazidim or cefepim)
Or (imipenem 2-3 g/d or meropenem 3–6 g/d or doripenem)
+ (amikacin or tobramycin) or ciprofloxacin 1500–2000 mg/d
or fosfomycin 150–200 mg/kg/d
for 2 to 4 weeks then followed by oral route if possible:
ciprofloxacin 1500–2000 mg/d | Cefepime 2 g/12 h (IV) + ciprofloxacin 750 mg/12 h (PO) or 400 mg/12 (IV)
Alternatives:
meropenem 1 g/8 h (IV)
+/− aminoglycosides or ciprofloxacin
If aminoglycoside in spacer and organism
Aminoglycoside- susceptible then double
coverage is provided with
recommended IV or oral monotherapy
ceftazidim 2 g/8 h (IV) |
|
| Anaerobes | Clindamycin 600 mg/6 to 8 h (IV)
For 2 to 4 weeks followed by
clindamycin 300 mg/6 h (PO)
| Gram-positive anaerobes (Peptostreptococcus spp., P. acnes…)
Amoxicillin 100–200 mg/kg/d
or cefazolin 6–80 mg/kg/d
or clindamycin 1,800–2400 mg/d if erythromycin susceptible.
Gram-negative anaerobes (Bacteroides fragilis, etc.)
Clindamycin 1800–2400 mg/d or metronidazole 1500 mg/d or amoxicillin-clavulanic acid 100 mg/kg/d | For P. acnes penicillin G 20 million/d (IV)
or
ceftriaxone 2 g/d (IV)
Alternatives:
clindamycin 600 to 900 mg/8 h (IV) or 300 to 450 mg/8 h (PO)
or vancomycin 15 mg/kg/12 h |
|
| Fungus | No recommendation | Liposomal amphotericin B 0.7 to 1 mg/kg
or
fluconazole 400 to 800 mg/d (if Candida sp. is susceptible)
or
voriconazole 6 mg/kg/12 h (day 1) then followed by 4 mg/kg/12 h (if candida is susceptible, Aspergillus sp.) | No recommendation |
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